Avofer Dosage/Direction for Use

Calculation of Dosage: Monitor carefully patients for signs and symptoms of hypersensitivity reactions during and following each administration of Avofer.
Avofer should only be administered when staff trained to evaluate and manage anaphylactic reactions is immediately available, in an environment where full resuscitation facilities can be assured. The patient should be observed for adverse effects for at least 30 minutes following each Avofer injection.
Posology: The cumulative dose of Avofer must be calculated for each patient individually and must not be exceeded.
Calculation of dosage: The total cumulative dose of Avofer, equivalent to the total iron deficit (mg), is determined by the haemoglobin level (Hb) and body weight (BW). The dose of Avofer must be individually calculated for each patient according to the total iron deficit calculated with the following Ganzoni formula, for example: (See Equation 1.)

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Below 35 kg BW: Target Hb = 13 g/dl and storage iron = 15 mg/kg BW.
35 kg BW and above: Target Hb = 15 g/dl and storage iron = 500 mg.
* Factor 2.4 = 0.0034 (iron content of Hb = 0.34%) x 0.07 (blood volume = 7% of BW) x 1000 (conversion of [g] to [mg]) x 10. (See Equation 2.)

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Total amount of Avofer to be administered according to body weight, actual Hb level and target Hb level*: (See Table 1.)

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To convert Hb (mM) to Hb (g/dl), multiply the former by 1.6.
If the total necessary dose exceeds the maximum allowed single dose, then the administration must be divided. If no response of the haematological parameters is observed after 1 to 2 weeks the original diagnosis should be reconsidered.
Calculation of dosage for iron replacement secondary to blood loss and to support autologous blood donation: The required Avofer dose to compensate for the iron deficit may be calculated according the following formulas: If the quantity of blood lost is known: The administration of 200 mg iron (10 ml of Avofer) should result in an increase in Hb approximately equivalent to 1 unit blood (400 ml with Hb = 15 g/dl).
Iron to be replaced [mg] = Number of blood units lost x 200 mg or;
Amount of Avofer needed [ml] = Number of blood units lost x 10 ml.
If the Hb level is less than desired: Formula assumes that the storage iron does not need to be restored. Iron to be replaced [mg] = BW [kg] x 2.4 x (target Hb - actual Hb) [g/dl].
Example: For BW = 60 kg and Hb decrease = 1 g/dl.
≅150 mg iron to be replaced.
7.5 ml Avofer needed.
For the maximum tolerated single and weekly dose, see "Normal posology" and "Maximum tolerated single and weekly doses" as follows.
Normal Posology: Adult: 5-10ml of Avofer (100-200 mg iron) 1 to 3 times a week.
For administration time and dilution ratio, see "Method of administration" as follows.
Paediatric population: There is moderate amount of data in children under study conditions. If there is a clinical need, it is recommended not to exceed 0.15 ml of Avofer (3 mg iron) per kg body weight not more than three times per week.
For administration time and dilution ratio, see "Method of administration" as follows.
Maximum tolerated single and weekly doses: Adults: As an injection, maximum tolerated dose per day given not more than 3 times per week: 10 ml of Avofer (200 mg iron) injected over at least 10 minutes.
As an infusion, maximum tolerated dose per day given not more than once per week: Patients above 70 kg body weight: 500 mg iron (25 ml of Avofer) over at least 3 ½ hours.
Patients of 70 kg body weight and below: 7 mg iron/kg body weight over at least 3 ½ hours.
The infusion times given in "Method of administration" as follows should be strictly adhered to, even if the patient does not receive the maximum tolerated single dose.
Method of Administration: Avofer must only be administered by the intravenous route. This may be by drip infusion, slow injection or directly into the venous line of the dialysis machine.
1) Intravenous drip infusion: Avofer must only be diluted in sterile 0.9% m/V sodium chloride (NaCl) solution. Dilution must take place immediately prior to infusion and the solution should be administered as follows: (See Table 2.)

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2) Intravenous Injection: Avofer may be administered by slow intravenous injection at a rate of 1 ml undiluted solution per minute and not exceeding 10 ml (200 mg iron) per injection.
3) Injection into venous line of dialysis machine: Avofer may be administered during haemodialysis session directly into the venous line of the dialysis machine under the same conditions as for intravenous injection.